Blood Clotting and Cholesterol Crystal Embolization

To the Editor.— In a recent article (241:807, 1979), Kempczinski described lower extremity arterial emboli from ulcerating atherosclerotic plaques. Neither heparin nor warfarin had been effective in preventing recurrent embolization.¹⁻³ We observed a 65-year-old man in whom, two days after initiation of treatment of bilateral femoral vein thrombosis with streptokinase, livedo reticularis of the lower part of the body developed; a few days later, necrosis of skin and toes and acute renal failure developed. The renal failure was treated conservatively; for several reasons, hemodialysis was not performed. At autopsy, severe ulcerative atheromatosis of the aorta with cholesterol crystal embolization (CCE) in both kidneys was found (Figure), as well as in the liver, spleen, prostate, and medium-sized and small femoral arteries. The time course and the finding of CCE in only the lower part of the body may suggest a lysis of the protecting thrombi from the aortic atheromas by